老年髋部骨折患者围手术期输血风险及短期预后分析

Analysis of perioperative blood transfusion risk and short-term prognosisin elderly patients with hip fracture

目的探究老年髋部骨折患者围手术期输血的风险及输血对短期预后的影响。方法收集2021年1月至2022年11月入住深圳市第二人民医院骨科的老年髋部骨折患者的临床资料,根据患者围手术期是否输血将患者分为输血组和未输血组。单因素及多因素logistic回归分析患者围手术期输血的独立影响因素,并比较两组患者短期预后差异。结果412例老年髋部骨折患者被纳入研究,围手术期输血257例(即输血组,62.4%),平均输血量为(4.10±2.52)U。单因素分析显示输血组与未输血组年龄、骨折类型、合并症(心功能不全、术前肺部感染、支气管扩张)、红细胞计数、血红蛋白、红细胞体积分布宽度、白蛋白、美国麻醉医师协会(ASA)分级、美国纽约心脏病协会(NYHA)心功能分级、手术方式、术中失血量、手术时间比较,差异有统计学意义(P<0.05)。多因素logistic分析显示术前血红蛋白水平低、心功能不全、术中失血量>200 mL、手术时间>120 min是老年髋部骨折患者围手术期输血的独立危险因素(P<0.05)。输血组患者住院及卧床时间较未输血组更长、住院费用更高、出院日常生活活动能力(ADL)评分更低(P<0.05)。结论老年髋部骨折患者围手术期输血风险高,术前血红蛋白水平低、心功能不全、术中失血量>200 mL、手术时间>120 min是老年髋部骨折患者围手术期输血的独立危险因素,影响患者短期预后。

Objective To investigate the risk of perioperative blood transfusion in elderly patients with hip fracture and its impact on short-term prognosis.Methods The clinical data of elderly patients with hip fracture admitted to the orthopedic department of Shenzhen Municipal Second People’s Hospital from January 2021 to November 2022 were collected.The patients were divided into the blood transfusion group and non-blood transfusion group according to whether or not having blood transfusion during perioperative period.The independent influencing factors for perioperative blood transfusion were analyzed by the univariate and multifactorial logistic regression,and the short-term prognostic differences were compared between the two groups.Results A total of 412 elderly patients with hip fracture were included in the study.There were 257 cases of perioperative blood transfusion(blood transfusion group,62.4%),and the average blood transfusion amount was(4.1±2.52)U.The univariate analysis showed that the age,fracture type,complications(cardiac insufficiency,preoperative pulmonary infection,bronchiectasis),red blood cell count,hemoglobin,red blood cell volume distribution width,albumin,ASA grade,NYHA cardiac function grade,surgical mode,intraoperative blood loss volume and operative time had statistical differences between the blood transfusion group and non-blood transfusion group(P<0.05).The multivariate logistic analysis showed that preoperative low Hb level,cardiac insufficiency,intraoperative blood loss volume>200 mL and operative duration>120 min were the independent risk factors for perioperative blood transfusion in elderly patients with hip fracture.The hospitalization and bed rest time in the blood transfusion group were longer than those in the non-blood transfusion group,the hospitalization expenses was higher and the activity of daily living(ADL)score was lower(P<0.05).Conclusion The preoperative blood transfusion in elderly patients with hip fractures has high risk.Preoperative low hemoglobin level,cardiac insufficiency,intraoperative blood loss volume>200 mL and operative duration>120 min are the independent risk factors for perioperative transfusion in elderly patients with hip fracture and affect the short term prognosis in the patients.